1. Hematological System KNH 413

2. Nutritional Anemias Macrocytic –B12, B9, B1, pyridoxine (B??) Decreased ability to synthesize new cells and DNA Microcytic – Iron, protein, vitamin C, A, copper, manganese Impaired heme synthesis Hemolytic- def or excess of vitamin E

4. Microcytic Anemias Iron deficiency- decreased RBC count Most common nutritional deficiency in U.S. Progression from negative iron balance to overt clinical iron-deficiency anemia Overt you have to supplement with pills or IV

5. Normal blood smear Iron-deficiency anemia

7. Microcytic Anemias Iron deficiency - etiology Blood loss; gastric ulceration, dysmenorrhea, inadequate intake… Functional anemia; oxygen is insufficient for erythropoiesis, not enough RBC, protein energy malnutrition, low HnH, ferriten (iron in the liver), transferrin (plasma protein) Depletion of iron in liver, spleen, other tissues results

8. Microcytic Anemias Iron intake and absorption considerations: Poor intake with increased needs Food sources – heme vs. nonheme Vitamin C increases absorption of iron Mineral excesses may bind iron

9. Microcytic Anemias Iron deficiency Infants and children “Milk anemia” Childhood obesity Iron-poor food choices, nut def foodstuff Pregnancy Fetal needs precede maternal needs © 2007 Thomson - Wadsworth

10. Microcytic Anemias Iron deficiency Immunity Decreases immune function Infections can increase Zinc and vitamin A deficiency are confounding factors Can cause more complications General malnutrition and repeated pregnancy with dietary deficiencies Hyperemesis

11. Microcytic Anemias Disease states associated with iron-deficiency anemia: H. pylori infection Impaired thyroid function Cancers Wound healing, sepsis, surgery Cerebrovascular or cardiovascular disease HIV/AIDS ALD- (ferritin because it is stored in the liver)

12. Microcytic Anemias Disease states associated with iron-deficiency anemia: HIV/AIDS GI disease Kidney disease Anorexia nervosa PKU- iron is decreased in the diet, growing years

13. Microcytic Anemias Special conditions that impact iron status: Athletes – esp. females The combination, higher RBD, menstruation Space flight – weightlessness Exposure to chemical or infectious agent Competing with receptors for iron, lead

14. Microcytic Anemias Clinical Manifestations Cold extremities, pallor, fatigue, malaise, tachycardia Laboratory indices Measure of hgb often done alone Noninvasive point of care imaging

16. Microcytic Anemias Treatment/Nutrition Therapy Iron-dense foods Nutrient-dense diet long term Treat underlying condition

18. Microcytic Anemias Treatment/Nutrition Therapy Supplementation – single vs. multivitamin Females 15-60 mg if iron deficient Pregnant women - 30 mg GI distress Weekly doses vs. daily

19. Microcytic Anemias Nutritional Implications Fatigue, depression, difficulty in physical exertion – poor intake Depressed appetite Geriatric population

20. Microcytic Anemias Interventions Enhance absorption with vitamin C Increase intake of animal sources Bioengineering Community level NHAINStudy

22. Megaloblastic Anemias RBCs have decreased capacity for oxygen transfer Large, irregular, immature Pernicious anemia – Specific to GI disorders

24. Megaloblastic Anemias Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk Gastrectomy and bariatric surgery Intake, digestion, absorption Inflammation Uracil accumulation- due to inadequate amounts of folate

26. Megaloblastic Anemias Clinical Manifestations Irritability, pallor, pale sclera Chromosomal damage Homocysteinemia- synthesis of methanine from homocysteine requires a folate coenzyme- oral B12, or folate supplement, weekly injections of B12

27. Megaloblastic Anemias Treatment/Nutrition Therapy Oral cyanocobalamin and supplemental folate Treat underlying causes Patient education on nutrient density

28. © 2007 Thomson - Wadsworth

30. Megaloblastic Anemias Nutritional Implications/Interventions Elevated homocysteine in children and adults Encourage animal foods if appropriate